Disturbed Eating Behaviors in Adolescents and Emerging Adults With Type 1 Diabetes: A One-Year Prospective Study

Abstract

Disturbed eating behavior (DEB) is prevalent in youth with type 1 diabetes and is accompanied by an increased risk for complications, morbidity, and mortality. Prospective studies on DEB in the challenging transition to adulthood are scarce. This longitudinal study examined DEB over a 1-year period and investigated the directionality of effects linking DEB to diabetes-specific functioning and depressive symptoms in adolescents and emerging adults. RESEARCH DESIGN AND METHODS Three hundred youth (16-28 years old) with type 1 diabetes participated in a twowave longitudinal study. Questionnaires measured DEB (Diabetes Eating Problem Survey-Revised [DEPS-R]), self-management, diabetes distress, and depressive symptoms. HbA 1c values were obtained from physicians. Mixed ANOVA and crosslagged analysis were used to examine prospective changes and directionality of effects, respectively. RESULTS Mean DEB remained stable in the total sample, but significant individual differences were observed based on the cutoff score of the DEPS-R: 19% displayed persistent DEB and 8% increased and 7.3% decreased in DEB over time. The remaining individuals scored low on DEB over time. These four groups were differentiated based on insulin restriction, omission, diabetes-specific functioning, and depressive symptoms. Cross-lagged analyses indicated that DEB predicted relative increases in depressive symptoms over time, whereas reciprocal associations with glycemic control were found. CONCLUSIONS This longitudinal study highlights the substantial impact DEB may have in the transition to adulthood, with a substantial portion of youth with type 1 diabetes being at risk for clinical DEB. Prospective pathways linking DEB to functioning were found, emphasizing the clinical relevance of assessing DEB over time. Type 1 diabetes constitutes a risk factor for developing disturbed eating behavior (DEB), including unhealthy weight-management behaviors, such as skipping meals, binge eating, and purging, as well as more severe eating disorders (1,2). DEB constitutes a substantial concern, as up to 30% of adolescent girls with type 1 diabetes display DEB (3-5

25 Years of psychological research investigating disordered eating in people with diabetes: what have we learnt?

“…Profiles or subtypes of disordered eating in type 1 diabetes may also differ with respect to their trajectories, with some investigations noting variability in the persistence of symptoms over time . A recent study examining disordered eating at baseline and 1‐year follow‐up in 300 adolescents and young adults with type 1 diabetes observed that 19% of their sample had persistent disordered eating, 8% had worsening disordered eating, and only 7.3% had a reduction in disordered eating . Goebel‐Fabbri et al .…”

“…Profiles or subtypes of disordered eating in type 1 diabetes may also differ with respect to their trajectories, with some investigations noting variability in the persistence of symptoms over time [5,6,16]. A recent study examining disordered eating at baseline and 1-year follow-up in 300 adolescents and young adults with type 1 diabetes observed that 19% of their sample had persistent disordered eating, 8% had worsening disordered eating, and only 7.3% had a reduction in disordered eating [17]. Goebel-Fabbri et al [18] explored persistence of insulin restriction behaviours in a sample of women with type 1 diabetes (n = 207), finding that those who ceased insulin restriction across the 11-year follow-up period showed less fear of weight gain with insulin, and fewer difficulties with diabetes self-management, relative to those who persisted.…”

“…pressure to conform to a ‘thin ideal’) and pubertal/developmental factors (e.g. peripubertal weight gain resulting in increased body dissatisfaction) ,]. However, although lower rates have been observed, disordered eating is still over‐represented in boys and men with type 1 diabetes relative to their those without diabetes , and body dissatisfaction in young men with type 1 diabetes has been reported to be high.…”

Health Care Transition in Type 1 Diabetes: Perspectives of Diabetes Care and Education Specialists Caring for Young Adults

“…24 The shortage of mental health care resources has previously been documented as a serious concern in the US. 25,26 Combined with the high prevalence of mental health problems such as depression, anxiety, and disturbed eating behaviors in ~10-35% of young adults with type 1 diabetes, 27,28 this shortage constitutes an obstacle for clinical care in this vulnerable age group. There is a need to address this gap in care to make mental health care more accessible and available.…”

Executive function mediates the link between externalizing behavior and HbA1c in children and adolescents with type 1 diabetes: A cross‐national investigation

“…An abundance of research demonstrates that youth are at risk for psychosocial and psychiatric problems, which are associated with worse self‐management and glycemic control 7,8 . However, to date, diabetes research tends to focus mainly on internalizing behavior difficulties such as depression, anxiety, distress, 9 and risk behaviors such as disturbed eating 10 . Despite their link to worse glycemic control in children and adolescents with T1D, 11‐13 externalizing behavior problems remain relatively understudied, and thus potentially under‐assessed in clinical practice.…”